GAO: Problems with survey methodology, guidance factor into understatement of deficiencies at nursin

General weaknesses in the nursing home survey process contribute to the understatement of deficiencies at nursing homes, a newly released report from the Government Accountability Office found.

Specifically, shortcomings in the traditional survey methodology, such as too many tasks, as well as problems with the guidance on identifying deficiencies played a role in the understatement. Workforce shortages, surveyor inexperience, inadequate training, and, in some cases, pressure from stakeholders, such as nursing homes, also were factors.

The GAO is making seven recommendations to the CMS administrator to address these issues. States, under contract with the Centers for Medicare & Medicaid Services, conduct surveys at nursing homes. The GAO over the past decade has reported inconsistencies, including understatement, in states’ assessment of nursing homes’ quality of care.